Somatostatin

Summary

Somatostatin is an endogenous cyclic tetradecapeptide (SST-14) produced in the hypothalamus, pancreas, and gastrointestinal tract. It exerts broad inhibitory effects on hormone secretion and cell proliferation. Pharmaceutical-grade somatostatin (e.g., Stilamin) is used clinically for acute management of bleeding esophageal varices, gastrointestinal bleeding, and inhibition of pancreatic secretion. Due to its very short half-life (~1–3 minutes), synthetic analogs (octreotide, lanreotide) are preferred for most clinical applications.

Mechanism of Action

Binds to somatostatin receptors (SSTR1-5), inhibiting the release of growth hormone (GH), insulin, glucagon, thyroid-stimulating hormone (TSH), and various gastrointestinal hormones; also suppresses exocrine pancreatic secretion and gastrointestinal motility

Routes of Administration

Goals & Uses

• Inhibition of pancreatic secretion / fistula managementGastroenterology / SurgeryModerate
• Suppression of growth hormone secretionEndocrinologyModerate
• Control of acute variceal bleedingHemostasis / GastroenterologyHigh
• Reduction of hormone hypersecretion in carcinoid/VIPomaOncology / EndocrinologyLow
• Management of acute gastrointestinal bleedingGastroenterologyModerate

Contraindications

• Known hypersensitivity to somatostatinAllergyHigh
• PregnancyPopulationModeratePotential fetal risk or insufficient safety data
• LactationReproductiveModerate

Adverse Effects

• Injection site reactionsLocalUncommon
• FlushingVascularUncommonWarmth and redness of the skin
• Nausea and vomitingGastrointestinalCommon
• Hypoglycemia / HyperglycemiaMetabolic / EndocrineCommon
• Abdominal discomfort / diarrheaGastrointestinalCommon
• BradycardiaCardiovascularUncommon

Drug Interactions

• Antihypertensives / Beta-blockersLow
• CyclosporineModerate
• BromocriptineLow
• Insulin / Oral hypoglycemicsModerate

Population Constraints

• Hepatic / Renal impairmentOrgan ImpairmentRelative
• Pediatric patientsAgeRelative
• Diabetic PatientsMetabolicRelative
• Patients with cardiac conduction disordersCardiovascularRelative

Regulatory Status

• European UnionApprovedApproved: Acute bleeding from esophageal varices, Acute gastrointestinal hemorrhage, Prevention of complications after pancreatic surgeryApproved in several EU member states (e.g., Italy) under brand names such as Stilamin; not uniformly approved across all EU members
• United StatesUnapprovedNative somatostatin not FDA-approved; synthetic analogs (octreotide, lanreotide, pasireotide) are used for relevant indications
• United KingdomUnknownSynthetic analogs preferred; native somatostatin availability limited; consult MHRA guidance

Native somatostatin is approved in some European countries (e.g., Italy) for acute GI bleeding and variceal hemorrhage. Not widely approved as a standalone agent in the US; synthetic analogs are used instead. The FDA has not approved native somatostatin; long-acting analogs are FDA-approved.

Evidence & Sources

No sources recorded yet.